Shirah Vollmer MD

The Musings of Dr. Vollmer

The Letter

Posted by Dr. Vollmer on March 21, 2011

Veronica, sixty-two, writes me a letter before her weekly appointment. I have known Veronica for fifteen years, but this letter writing activity is only within the last six months. She has termed our current chapter as a “crisis,” meaning that she feels that I have “gotten too hard” on her. The letters always reassure me that she will see me at our weekly time. She is as reliable as they come. Still, the prose portrays the agony she experiences between our sessions. She feels like I “have lost patience with her.” In fact, I have been more direct in my comments, which I believe she has taken as character assaults, and not as understanding her character. As usual in my work, there is a very narrow path between character assassination and insight. Helping Veronica develop an “observing ego” as Freud would say, is my task. Veronica’s need to see herself in a brighter light than I see her, at times, creates her despair, creates the “crisis”. On the one hand, Veronica has deep trust in my opinions; she told me that. On the other hand, she sees my current view of her as “harsh and far from how I see myself.” “Therapy can be hard because we have to face our demons,” I say. “That is too trite. You are better than that,” she tells me. “If I say you are not taking responsibility for your own life and that rings true, then there is something to think about. If that does not ring true, then I am off-base. If it rings true sometimes, but not all the time, then it gives you agony, so maybe that is what you are going through.” I say, helping her see herself in layers. Veronica is not happy. “We are in a crisis,” she repeats.

5 Responses to “The Letter”

  1. John Wheeler said

    Sometimes patients can end up feeling overcooked….

  2. Shelly said

    Maybe Veronica comes to you for understanding and empathy, and not self-insight. You know, like just a friendly ear and someone to talk to? A friend doesn’t offer self-insight, a friend only sympathizes. Or does Veronica tell you that she really wants to hear what you have to say, what you really think?

    • Shirah said

      Ten years changes the dynamics of the relationship. Understanding and empathy are good for a long time, but there comes a time when a deeper, more critical view of oneself, can be helpful. I agree with you though, if Veronica does not see it as helpful, then I need to re-examine my technique.

  3. Ashana M said

    Other’s views of us are not necessarily more accurate than our own: they are simply informed by different needs and biases. Your presumption that you are being helpful to her in doing what you are doing and also that you are successful in it are your biases. Veronica is perhaps biased towards seeing herself as a responsible and self-aware person. One of these views may be more accurate than the other, or they may both be inaccurate to the same degree.

    What is usually painful about it is the discrepancy between our own views of ourselves and the views other people have of us. We usually either alter our own views of ourselves or find a way to avoid seeing the other’s conflicting view of us. But she sees you as authoritative–you have the position and behaviors of an authoritative person. So her views of authority and what she expects of it are also at stake, and not just her view of herself or her view of you as an individual.

    It sounds like she sees you as the “good doctor” who is always right and whose instructions need to be followed to get well. But she disagrees with you. Doing that requires she re-examine her views of authority–opening the door to having no authority she can trust implicitly at all. In other words, disagreement would require that she change her view of you in particular and authority in general in a way she does not want to. It’s easier to keep asking you to remain the person she would prefer you to be and to return to behavior that is consistent with how she believes authority should function–which is to have views she doesn’t need to disagree with.

    This is an old post. How did it all turn out? What did you end up doing?

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